**Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**
1.
Do you possess a bachelor’s degree from an accredited college or university in nursing, social work, psychology, education or counseling?
Yes
No
2.
In which field of study is your degree? If you do not have a degree, enter N/A.
3.
Describe your professional work experience related to the support services and programs for developmentally disabled clients.
Please include name of employer, job title, dates of employment, and hours worked per week. This information must also be reflected in your application. If you do not possess experience in this area, put N/A in the box below.
4.
Describe your professional experience in health services. Health services is defined as experience in areas other than Mental Health, Developmental Disabilities or Addictions.
Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application. If you do not possess experience in this area, put N/A in the box below.
5.
Describe your knowledge of the CMS Community Setting Rule.
Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application. If you do not possess experience in this area, put N/A in the box below.
6.
Describe your experience with DDA funded providers. This experience must also be reflected in your application. If you do not possess this type of experience, please indicate N/A in text box.
Department of Budget and Management